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Substance Abuse Prevention for the LGBTQ+ Community

The LGBTQ+ community is large and made up of a diverse group of people, all with unique identities and from different backgrounds. However, rates of substance use and abuse are significantly higher across this population than in cisgender, heterosexual individuals. In fact, recent research exploring substance use trends in the LGBTQ+ community discovered that individuals in this population are more likely to use illegal drugs, smoke cigarettes, drink alcohol, and have substance abuse disorders. Further, these higher rates of substance use were noticed across “subgroups of adults defined by sex and by age group,” suggesting that this is a serious and significant issue that could affect all members of the LGBTQ+ community.

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In the United States, it’s estimated that 4.5% of the population is lesbian, gay, bisexual, or transgender. This means over 14 million people in the U.S. alone are at a significantly higher risk of misusing substances or developing a substance use disorder. Misusing substances can have devastating and far-reaching consequences for individuals themselves, their friends and family members, the healthcare system, and the LGBTQ+ community as a whole. In order to effectively address this issue and better support people struggling with substance use, it’s crucial to understand more about the LGBTQ+ community, how and why substance abuse affects this population, and what treatment solutions and resources are available that can help LGBTQ+ individuals overcome this issue.

Unique Challenges Facing the LGBTQ+ Community

The LGBTQ+ community faces myriad unique challenges that heterosexual, cisgender individuals do not. Someone’s sexual orientation or gender identity does not intrinsically cause problems or make them abuse substances; rather, the difficulties the LGBTQ+ community faces stem from external factors and societal attitudes regarding their sexual orientation or gender identity. Some of the biggest challenges include:

  • Social stigmas about sexual orientation and gender identity;
  • Harassment and discrimination based on sexual orientation and gender identity;
  • Lack of support or outright rejection from family members;
  • Lack of social support from friends, peers, colleagues, or community members;
  • Internalized homophobia or transphobia, or other confusing, complicated feelings about sexual orientation and gender identity;
  • Local or national legislation promoting stigmas against the community or denying LGBTQ+ individuals civil rights;
  • Inability to safely come out or disclose sexual orientation or gender identity.

For many LGBTQ+ individuals, these issues can occur on a daily basis. They can affect every aspect of daily life, from minor interactions and casual conversations to more serious quality-of-life factors, including employment and housing. Many experts view these challenges, pressures, and stressors through the lens of minority stress. This framework suggests that members of stigmatized minority groups experience higher levels of chronic stress for longer amounts of time because of widespread, large-scale discrimination and prejudice.

Minority stress has been shown to have multiple negative health outcomes for the LGBTQ+ population, including physical health problems, effects on mental health, and a decline in overall wellbeing. Additionally, minority stress has also been linked to substance use among members of this community. When faced with these constant stressors, some LGBTQ+ individuals may turn to harmful substances as a way to cope. Though this coping mechanism can provide temporary relief from these problems, it can create even more health issues down the road or lead to a dependency on these substances.

Effects of Substance Abuse on the Community

Whether or not someone is part of the LBGTQ+ community, when someone misuses substances or becomes dependent upon them, it doesn’t just affect that person or their loved ones. It can actually have a huge impact on other members of the LGBTQ+ community and society as a whole. Some of these far-reaching and potentially devastating consequences include:

  • Crime Rates: Substance use is closely associated with crime and can lead to higher crime rates. Often, people may get involved in illegal activities to obtain drugs (particularly illicit ones), or commit crimes when using substances. This, in turn, puts a greater strain on law enforcement, the courts, and the entire criminal justice system. It can also affect other people who were involved in the crime, or who were a victim of it, as well as their family members.
  • Homelessness & Poverty: Becoming dependent on any kind of substance can lead to financial troubles for that individual and other members of their household. In extreme cases, this can lead to poverty or even homelessness, which LGBTQ+ youth are already at a disproportionately high risk for. This can put additional stress on welfare systems, already-crowded homeless shelters, and other public funds and institutions.
  • Social Isolation: People who abuse substances may become withdrawn in order to use or drink. Their relationships with friends and family members may become strained, they may lose interest in their hobbies, or they may have problems at work — all of which have further impacts on the people in their lives. Further, social isolation can be difficult for anyone to cope with, and for some higher-risk populations, such as older adults, it can even be deadly.
  • Healthcare System: Using substances can put a greater strain on the nation’s healthcare system and all its medical professionals, from administrative staff to newly certified nursing assistants (CNAs) to experienced doctors and specialists. If someone needs medical care because of their substance use, whether it’s an accidental overdose or a related chronic health problem, healthcare workers must treat them. This diverts attention, resources, and expertise away from other people who need care, and greatly increases healthcare spending.

Though choosing to use substances of any sort seems like an individual choice, it ultimately has a ripple effect that can both directly and indirectly impact other people, communities, and institutions across the United States.

Drugs Most Frequently Used

Any type of drug or substance, regardless of its legal status, can be misused or abused. However, some substances are used more frequently than others, especially by members of the LGBTQ+ community. According to the 2018 National Survey on Drug Use and Health: Lesbian, Gay, & Bisexual (LGB) Adults, these are the major substance use trends among the LGBTQ+ community:

  • Alcohol: A majority of LGB youth and adults drink alcohol, with 64.3% of people ages 18 to 25 and 64.7% of people age 26 or older admitting to imbibing. About 12% of LGB youth and adults claim to have alcohol use disorder. Only about 55% of the overall U.S. population drinks alcohol, indicating that alcohol use is significantly greater among the LGB community. Further, a growing body of research indicates that transgender individuals may be more likely to use alcohol than cisgender individuals and experience more severe consequences when doing so.
  • Cocaine: Cocaine is used less frequently than other substances, but it is still more commonly used by the LGB population than by the general population. 2.5% of LGB youth and adults report cocaine usage, compared to just 0.7% of the general U.S. population. Transgender youth are more than twice as likely to use cocaine at least once in their lifetimes than cisgender youth.
  • Marijuana: Marijuana is the illicit drug used most frequently by both members of the LGB community and the general U.S. population. Despite its widespread prevalence, marijuana use is still significantly higher among adults in the LGB community. 37.6% of LGBTQ+ individuals over the age of 18 have used marijuana, compared to just 16.2% of the general adult population. Per the 2015 U.S. Transgender Survey, 64% of transgender individuals have used marijuana at least once, while 25% do so on a regular basis.
  • Methamphetamine: Similar to cocaine, methamphetamine use is significantly lower than that of other substances, but is still higher among LGB individuals than the general population. While just 0.7% of the overall U.S. population over 26 report methamphetamine usage, almost 3% of LGB adults over 26 report doing so. The same study of transgender middle school students linked above also found that transgender youth are more than twice as likely to use amphetamines at least once in their lives than their cisgender peers.
  • Prescription Drugs: While prescription drugs may be legal, they can still be misused and abused when taken incorrectly, for non-medical purposes, or by someone who was not prescribed the drug. This includes prescription stimulants (such as Adderall and Ritalin), pain relievers (such as Hydrocodone), sedatives (such as Ambien), and tranquilizers (such as Xanax and Prozac). Regardless of the type of prescription drug, usage was higher among LGB individuals than the general U.S population. Per the 2015 Transgender Survey, over one-third of transgender individuals have used prescription drugs of any kind for non-medical purposes.
  • Opioids: 8.5% of LGB adults age 18 to 25 use opioids in some form, as do 9.3% of LGB adults over the age of 26. Since 2015, opioid misuse has decreased among younger LGB adults, but increased among those over age 26. Additionally, transgender individuals are more than three times as likely to misuse opioids than cisgender counterparts, regardless of their sexual orientation.
  • Tobacco: Although not illegal, tobacco usage is also higher among members of the LGB community. 20.5% of LGB adults smoke cigarettes, compared to 15.3% of heterosexual adults. Transgender individuals are also more likely to smoke or use tobacco products than their cisgender peers.

Co-Occurring Disorders & Substance Abuse

Substance use disorders are complex and closely related to other mental health conditions. In fact, substance use disorders commonly co-occur with other mental illnesses. This is referred to as a “co-occurring disorder.” Over seven million adults in the U.S. have been diagnosed with co-occurring disorders. In addition to being more likely to have a substance use disorder, LGBTQ+ individuals are also more likely to have co-occurring disorders.

Although it can vary greatly from person to person, co-occurring disorders can be both a reason for and a result of substance abuse. People experiencing mental illnesses may turn to substances as a coping mechanism; conversely, using substances can cause a decline in mental health. It can be difficult to determine which condition arose first, especially since they may change in severity over time, but both conditions are usually treated simultaneously.

Some of the most common mental health conditions that co-occur with substance use disorders include:

Anxiety Disorders

Anxiety disorders are typified by overwhelming feelings of nervousness, worry, and fear. Temporarily feeling anxious is a normal part of daily life, but when someone has an anxiety disorder, those feelings may not go away; in some instances, they can worsen over time. There are several different types of anxiety disorders — including generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias — and someone can be diagnosed with more than one at the same time.

Research studying the intersection of anxiety disorders and substance use suggests that people with an anxiety order may self-medicate as a way of coping. This can lead to the development of a substance use disorder, as well as more severe anxiety symptoms, especially when sober. The study linked above also notes that individuals with co-occurring anxiety and substance use disorders tend to have greater difficulties and impairments in day-to-day activities.

Borderline Personality Disorder

Borderline personality disorder (BPD) is “an illness marked by an ongoing pattern of varying moods, self-image, and behavior.” Symptoms of BPD include extreme mood swings, difficulties maintaining stable relationships, distorted self-image, and impulsively engaging in risky or dangerous behaviors. BDP was once thought to be difficult to treat, but in recent years, treatment options have greatly improved, including new forms of psychotherapy and medication.

BPD frequently co-occurs with substance use disorders, and, in some instances, with more than one. One study suggests that as many as 25% of people diagnosed with a substance use disorder also meet the criteria for a BPD diagnosis. Additionally, an expanding pool of research shows there is a close link between BDP and being a part of the LGBTQ+ community, especially when compared to other personality disorders.

Depression

Depression is a mood disorder characterized by a low or sad mood across most activities and situations for at least two weeks. It is one of the most common mental health conditions in the world, and the World Health Organization estimates that as many as 264 million people suffer from some form of depression. There are several different types, some of which persist for longer amounts of time (such as clinical depression and persistent depressive disorder) or only arise in certain situations (such as postpartum depression or seasonal affective disorder). Common symptoms of depression include feelings of sadness or hopelessness, sudden changes in appetite or sleep schedule, and loss of interest in hobbies or enjoyable activities.

Depression frequently co-occurs with other mental health conditions, as well as substance use disorders. Alcohol use disorders are more common than drug use disorders among people with other major depressive disorders. In addition to being at a greater risk of substance use disorders, both LGBTQ+ youth and adults are more likely to experience depression than their heterosexual, cisgender counterparts.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a condition that can develop after witnessing or experiencing a dangerous, terrifying, or otherwise traumatic event. Many events and situations can cause trauma, including assault, the death of a loved one, or abuse. It’s natural to feel scared, stressed, or upset both during and after a traumatic situation, but when those feelings persist long after it’s over or interfere with daily life, it may constitute PTSD. Flashbacks or bad dreams, trying not to think about the event, and being jumpy or easily startled can all be symptoms of PTSD.

PTSD and substance use disorders are closely linked; as many as half of the individuals seeking treatment for substance use disorders meet the criteria for a PTSD diagnosis. Further, individuals diagnosed with PTSD are more than twice as likely to meet the criteria for a substance use disorder than individuals who are not. LGBTQ+ individuals are at a greater risk of developing PTSD at some point in their lives. Some researchers attribute this risk to the “greater exposure to violence, exposure to more potentially traumatic events, and earlier age of trauma exposure” that may occur when families and communities reject LGBTQ+ individuals because of their gender identity or sexual orientation.

Schizophrenia

Schizophrenia is “a chronic, severe mental disorder that affects the way a person thinks, acts, expresses emotions, perceives reality, and relates to others.” Compared to other mental health conditions, it is uncommon, affecting only an estimated 0.25% to 0.64% of the U.S. population. Although rare, it can be incredibly debilitating when left untreated, with symptoms such as hallucinations and delusions.

Again, schizophrenia is much less common than other mental health conditions, but it has high rates of co-occurrence with substance use disorders. As many as 47% of individuals diagnosed with schizophrenia have a severe problem with drugs or alcohol at some point in their lifetime, compared to just 16% of the general population. Like other mental health conditions, LGBTQ+ individuals are more likely to be diagnosed with schizophrenia, especially gay and bisexual men. Schizophrenia that co-occurs with substance use disorders is associated with significantly higher risks of negative health outcomes and greater difficulties accessing treatment. These challenges may worsen already-existing disparities in healthcare for LGBTQ+ individuals.

Disparities in Healthcare & Treatment for the LGBTQ+ Community

On top of being at a greater risk for developing substance use disorders and certain mental health conditions, members of the LGBTQ+ community also face greater challenges when accessing healthcare services and receiving effective treatment. There is no single cause for these care disparities among LGBTQ+ individuals — the reasons members of this community are either unable or unwilling to seek treatment are varied and diverse, such as:

  • Discrimination: Many LGBTQ+ individuals face discrimination on the basis of their gender or sexual orientation when trying to access healthcare. Per a survey from the Center for American Progress, 8% of LGB patients claim that a doctor or healthcare provider has refused to see them because of their actual or perceived sexual orientation; 29% of transgender patients have had the same issue, based on their actual or perceived gender identity. Being discriminated against or denied health services at any time also makes LGBTQ+ patients less likely to seek treatment in the future, even from different providers.
  • Fear: Some LGBTQ+ individuals are afraid of being discriminated against or harassed when seeking care. The 2015 Transgender Survey reports that almost one-quarter of transgender individuals put off healthcare services they needed because they were afraid of being mistreated. Additionally, even if LGBTQ+ individuals do seek care, they may be too afraid to come out to their healthcare provider, which can limit the effectiveness of their treatment and may prevent them from getting services they need.
  • Insurance Coverage: Not all states require health insurance coverage to be LGBTQ-friendly. Some individuals may not have coverage at all because of their gender identity or sexual orientation. Transgender individuals, in particular, are excluded from coverage, making it more difficult to access care for typical health problems, substance use disorders, or gender/transition-related issues.
  • Lack of Knowledgeable Providers: Many healthcare professionals are not knowledgeable about LGBTQ+ health. In some cases, LGBTQ+ individuals may have to teach their providers about their community and their unique health concerns. If doctors, nurses, and other providers aren’t educated about LGBTQ+ health issues and treatments, they cannot provide the full spectrum of care members of the LGBTQ+ community need to live healthfully.

Improving education about LGBTQ+ health among medical professionals is perhaps the best solution to addressing these issues and overcoming these barriers. Lack of training and education can have a direct impact on patient outcomes and ultimately result in suboptimal care. Simply put, cultural diversity in healthcare is a necessity to ensure all patients, regardless of their background or identity, receive the care they need.

Healthcare workers who interact with patients on a daily basis, like nurses and CNAs, are a crucial part of this solution. Part of a CNA’s job duties is specifically to communicate with and comfort their patients, and they must be able to do that for LGBTQ+ patients, no matter what their personal attitudes or beliefs are. Doing so may contribute to more positive health outcomes, both in the short- and long-term, for that patient — which is precisely why comprehensive CNA training is so important. However, this doesn’t just apply to CNAs and nurses; everyone, from doctors to administrative staff, must be able to work with every person who comes into their practice for treatment. By making an active effort to provide the best care for every patient and taking steps to learn as much as possible about LGBTQ+ health, it’s possible to eliminate these healthcare disparities for the LGBTQ+ community.

Substance Abuse Prevention Tips for the LGBTQ+ Community

While education about treatment for LGBTQ+ health issues is important, so is preventing substance abuse among members in this community. When done effectively, prevention is thought to be the best strategy for reducing rates of substance use and lessening its overall societal impact, particularly among adolescents and youth. Because LGBTQ+ individuals are at a significantly greater risk, it’s especially important to focus on preventing substance use before anything else.

  • Be Aware of Risk Factors: LGBTQ+ individuals must be aware of risk factors that can make them more likely to use substances. In addition to factors such as discrimination or rejection because of sexual orientation and gender identity, this includes more general risk factors such as family history, previous life experiences, and individual health issues.
  • Educate: Education about substance use is vital to prevention. Conversations about substance use in general, as well as about substance use in the LGBTQ+ community, should begin at an early age and take place as part of an open and ongoing discussion.
  • Know the Signs: Everyone should be aware of the warning signs of substance use so they are better able to detect it. Though using substances doesn’t necessarily mean someone has a disorder or is dependent upon them, being able to identify substance use allows others to intervene before larger health issues develop.
  • Support: Receiving support from family members, friends, colleagues, and community members is a major protective factor against substance use. While this doesn’t guarantee that someone won’t experiment with substances or develop a substance use disorder, it can significantly lower their risk of doing so. This is especially important for LGBTQ+ individuals, as they are more likely to lack this support.

Resources for Intervention, Treatment, & Recovery

In addition to preventing substance use, there are also myriad resources available for intervention, treatment, and recovery. For more information and support in helping LGBTQ+ individuals with substance use, please consult the following resources:

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